Background: Acute pain and systemic opioids may both negatively impact respiratory function after cardiac surgery.\nThis study analyzes the local practice of using intrathecal morphine analgesia (ITMA) with minimal parenteral opioid\nadministration in cardiac surgery, specifically the impact on postoperative pulmonary complications (PPCs).\nMethods: Data from adult patients who underwent elective cardiac surgery between January 2002, and December 2013\nin a single center were analyzed. Propensity scores estimating the likelihood of receiving ITMA were used to match (1:1)\npatients with ITMA and patients with intravenous analgesia (IVA). Primary outcome was PPCs, a composite endpoint\nincluding pneumonia, adult respiratory distress syndrome, and any type of acute respiratory failure. Secondary outcomes\nwere in-hospital mortality, cardiovascular complications, and length of stay in the intensive care unit (ICU) and hospital.\nResults: From a total of 1ââ?¬Â²543 patients, 920 were treated with ITMA and 623 with IVA. No adverse event consequent to\nthe spinal puncture was reported. Propensity score matching created 557 balanced pairs. The occurrence of PPCs in\npatients with ITMA was 8.1% vs. 12.8% in patients with IVA (odds ratio, 0.6; 95% CI, 0.40ââ?¬â??0.89; p = 0.012). Fewer patients\nwith ITMA had a prolonged stay in the ICU (> 4 days; 16.5% vs. 21.2%, p = 0.047) or in the hospital (> 15 days; 25.5% vs.\n31.8%. p = 0.024). In-hospital mortality and cardiovascular complications did not differ significantly between the two\ngroups.\nConclusion: In this study involving cardiac surgical patients, ITMA was safely applied and was associated with fewer\nPPCs
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